This is your brain on the gridiron: Are sub-concussive hits the most dangerous of all?

By Dr. Julian Bailes

Mar 09, 2011 | 4:00 AM

Philadelphia Eagles' DeSean Jackson lies on the field after suffering a concussion. (Slocum/AP)

Over 100 years ago, American football stood at a crossroads. By 1904, the relatively young sport had already produced 18 deaths and 145 serious injuries. President Theodore Roosevelt - threatening to abolish the sport - convened key participants in the collegiate circuit to undertake a major overhaul of the rules of play. Leaders of Harvard, Princeton, Yale and other universities crafted crucial changes that ultimately secured football's survival.

A century later, we are wrestling with a similar challenge. Though the gridiron has been made safer over the years through rule modernization and equipment advances, we are still struggling to reconcile the violent and beautiful game - which is also a multibillion-dollar business - with its real-life health effects. And, contrary to what you may believe, the problem is not just those startling helmet-to-helmet hits that give players concussions or worse.

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As a neurosurgeon who loves football and played it for many years, I must acknowledge this painful truth: Perhaps just as serious a health problem, if not more serious, are the hundreds of high-velocity hits that are a routine part of the game, week in and week out.

The recent suicide of 11-year NFL veteran Dave Duerson shines new light on the problem. Though it will be months until analysis of his brain tissue reveals whether or not he suffered from chronic traumatic encephalopathy, the most-feared degenerative brain disease in cases like this, the specter of chronic brain damage in football now exists even for those who were not known to have sustained concussions.

It was Albert Einstein who helped us understand why. In 1905, building upon the work of other leading physicists, Einstein crafted his iconic theory of mass and energy equivalence. One key revelation: While energy is dependent on mass, the more important factor is velocity, which has an overwhelming influence on the physics of a collision.

Given the speed at which the modern game of football is played - with rapid acceleration and deceleration in almost every tackle - tremendous amounts of energy are repeatedly transmitted to players' bodies and brains.

While modern helmets are part of the solution, they may in some ways contribute to the problem.

The helmet has evolved so that it is heavy and protective against major injuries, and this has led to players using their heads as battering rams, often with no hesitation. When this results in a concussion, we are, at least from the vantage point of diagnosing the problem, almost fortunate - we know that the brain has been jostled and can then tend to it. But there are many other times when there may not be a concussion suspected, and the sum of these "subconcussive" blows may cause serious harm. Organized football, at all levels, needs to go beyond its admirable work in trying to prevent helmet-to-helmet hits and concussions - and address the additional issue of repetitive head blows. We must work to reduce and remove head impacts from the game as much as possible.

I love football and want it to survive and thrive. I have young sons, and I will allow them to play if they are interested.

But just as a great coach knows how to study film and adjust his strategy, we must take a hard look at the reality of high-velocity collisions - and prepare to change the game itself. Otherwise, our society risks supporting a win-at-all-costs mind-set, similar to the manner in which the Romans approached their gladiator games. The fans may be cheering, but the players will be casualties. We must ensure that football is around for future generations to enjoy, including those who once played the game.